ERA testing after multiple implantation failures. Anyone had it done?

[seven201]

I've had four transfers so far (first 3 from 1 batch, fourth from a second egg collection) and 4 BFNs. I have a naturally conceived 4 1/2 year old and had a natural pregnancy with early miscarriage a bit over 3 years ago. My lining struggles to get to thickness, I have polycystic ovaries (on sukkarto), a fibroid, slightly high thyroid thingy (on levothyroxine), high bp (on meds) and a midline septum (ridge/divide in the uterus). I had surgery to unblock a tube 2 years ago. I'm in the healthy weight range.

My clinic have suggested PGS testing (we have 5 embryos in the freezer) but I'm really not keen on it as I've read about actually fine embryos being shown as poor and therefore being disposed of.

They also suggested ERA (endometrial receptor assessment). Has anyone had that done and found it useful? I just hate anything that delays the next FET but I think maybe it will be worth it?

Any other suggestions? Last FET I was on lots of estrogen, extra progesterone injections, clexane, neupogen infusion, aspirin and probably a whole load of other stuff I've forgotten.

I am so fed up with it all!

MLS!

Thank you both. Will take a paracetamol. The comfortably full bladder is nearly impossible I find. I think I've only had one procedure where the first catheter worked, they always ask for a different one, once they had to use a third! I even went in for a dummy run transfer to find the right catheter for me, but it still never just works for me. Maybe it's my niche too. I think I have a tilted uterus and also that ridge, so maybe it's that. I think when I have a fullish bowel (but can't go) they have the hardest time!

@Blondeshavemorefun you said on your FeT cycle you took oestrogen a bit longer? Was that longer than your ERA cycle? I’m just worrying my FET is going to be a diff number of days that I start my oestrogen vs ERA (12 days before I started progesterone and prob 16 before I start progesterone).
What were your ERA results out of interest? Thank u!

Yes I took for think 3/4w longer as was on holiday (June) and then clinic was shutting for summer they shut all aug

So they said try taking while I was away. Then came back. Got scanned the next day to check level of lining which was 1.1 and as lining was same as if been taking for 11/13 days when usually get scanned for fet before taking the pesseries , we decided to carry on with cycle

My era did show I needed longer then the usual 19/20day implant

So we took the risk of taking for longer abs lining could have been too thick but it was perfect thickness and had triple layer

As I said that was the only cycle out of 5 that worked, the only bfp in 10yrs of ttc

Dd is now just 4 and truely our miracle baby

Thanks blondeshaven. I’m a bit worried my lining might grow in between and so my era lining and fet Lining will be different and I’m not sure if that matters or I’m overthinking!

Hello, just to say that I posted a few days ago under agesandages11 but I use temp emails to make these accounts and forgot the other one's login details.

Just to summarise, been through my first IVF cycle which didn't work. Two blasts - one failed fresh transfer and one tested aneuploid.

I'm a very proactive person so am considering getting an ERA + EMMA + ALICE done before we move into my next egg retrieval which will hopefully start with my next period at the end of this month.

Am I being crazy to do this? I guess that I'd rather know now if my implantation window is unusual, vs. 'wasting' a euploid embryo (we will be PGT-A on all embryos this time round). I would be going to another self-referral location vs. going through my clinic, as the costs seem to be the same and I'd think it's faster for me to sort it out myself vs. trying to badger my clinic for it. I would then naturally share the results with them if we did get to the point of any FETs.

For those of you who remember my previous thread, I had a horrible consult with my clinic. I had been very excited as my conversation had been brought forward a week and 'upgraded' to the most senior individual at the location. Unfortunately they were ten minutes late to join the call, and then clearly had not reviewed any of my notes or had anything related to my cycle to hand. It was extremely upsetting and I ended up filing a complaint. The complaint was responded to very promptly, and I've been told they're arranging another consult for me.

Due to me pushing for things, I have now undergone some blood tests for LH/FSH, TSH and testosterone in the hopes that I can get a PCOS diagnosis (I have PCO, but suspect I'd be phenotype C PCOS in that I am ovulatory but possibly have hyper-androgenic symptoms) and much better tailoring of my protocol for this next cycle. Hope to be able to discuss these when they get this other consult in place.

Just to add, as I'm ovulatory, I would want my FETs to be similarly unmedicated, so that's why I feel able to organise an ERA by myself as I don't need a protocol to simulate anything.

Hi again @agesandages111 firstly I am sorry to hear about your appointment, I know you were looking forward to it. Unfortunately this seems to be the norm when it comes to larger fertility chains, the doctors are clearly under time pressure. I suspect that’s how my thin lining was missed back in September. I hope the next consultation is more productive.

If you’re doing natural FET then ERA may not be that helpful. The EMMA and ALICE would be useful though, the microflora is incredibly important. If I redesigned the UK IVF process I would put people through ERA/EMMA/ALICE before a medicated FET, one of my friends with a DOR has had it prior to any transfer, her specialist always does them before transferring embryos in his DOR patients, the embryos are clearly very precious in these cases and the trial and error approach isn’t appropriate. I would also push for either a HSG or saline scan for UK patients, in other countries this kind of imaging is routine and it seems crazy that we just assume all UK patients have a normal uterus from the limited US scan.

@Cream123 as far as I’m aware the time on estradiol doesn’t impact on the ERA advice. My specialist has spoken about potentially keeping me on estradiol for much longer than usual to give me the best lining in the future. As long as the progesterone is timed as per the results of the ERA then you should be fine to be on the estradiol for shorter/longer, the emphasis should be on you starting the progesterone when the thickness/appearance is good.

Hi @Gardenlady543, thank you for your kind words - it was quite shocking as the first half of the appointment was pretty much generic information and asking me questions that I had answered six months ago when we first engaged with the clinic (we started investigating IVF last year). I actually had to interrupt and say that I had a list of questions I wanted to go through - it was when I started asking these that it was clear they had none of the info from my recent cycle. When I mentioned this in the complaint and asked if I was being delusional to expect that we were going to discuss my cycle in depth and agree plans moving forward, I was reassured when they said that absolutely should have happened. I just hope I can get another consult arranged ASAP.

Are ERA not useful for natural cycles then...? Just thinking that with the transfers only possible on certain days, I thought it was still useful to know when your best window of receptivity is, or at least have the confirmation that you don't need any special treatment. The newest worry I've gotten into my head is that I have endometriosis, so am also trying to investigate organising a ReceptivaDX.

Hope things are alright with you and your Ashermans' investigations.

@agesandages111 I’ve just sent you a PM about the consultant I’m under.

I’m not sure about what they’d put on the form in a natural ERA, because they have to note how long someone’s been on the progesterone for. It may tell you if you’re receptive but given that it’s a natural cycle, maybe your body will do something different in your next cycle. If it comes back that it’s not receptive what would you do then? You’d probably have to go through a mock FET with another ERA.

You know I keep thinking what if I have silent endometriosis, although I have no evidence that I do and had a good yield of embryos. There are still so many possibilities for what’s going on in my case, I have a HSG this Thursday, and then my ERA/EMMA/ALICS results should be back the following week. So hopefully I’ll know more soon.

@Gardenlady543 thanks. I’ve been debating cancelling my very much wanted holiday! But I knew I was being silly but I tend to over think and analyse things too much. They say era and fet should be the same but don’t say how much of it should the same! I’m quite happy now being on longer no of days... but I’m wondering what if lining gets a lot thicker in that time. Will that be ok?

@Cream123 I mean I think that’s more about the type and timing of progesterone. While really really thick lining can be an issue, my understanding is generally it’s the thicker the better. Once progesterone starts there are changes in the thickness in the lining too, mine seemed to compact a lot in the FET cycle. If I could decide on a thickness cut off for me, I’d probably want to go up to around 12mm, that seems to get good results.

@Gardenlady543 silent endo was the last thing I was about to look into before my son worked out. I think once u have ur hsg and Emma results that will give u a good plan. If your hsg is normal as our other tests you could look into that. However if hsg shows something you may feel that’s your answer. Not long till your hsg!

@agesandages111 sorry about ur experience. I’ve found same . And I’ve found no one really cares enough! You have to be super proactive and take charge in this infertility world. Don’t think it’s silly to do it I’ve done it after 2 fails.

@Gardenlady543 my era cycle
Day 10 was 6mm
Then I added in 2 vaginal tablets and in 2 days I shot up to 10mm. Then I started progesterone

On the FET cycle i was going to copy it all and add the vaginal tablets in. But I’ll have 5 days of vaginal oestrogen on board and worried lining will jump to 12-14 and that may affect the window?? Do u see wot I mean ? But I agree it’s about the progesterone exposure timing...(though I saw the results r invlaid if u loose of gain 50 pounds roughly so obviously things can affect it)

Not sure why I’m worrying when my issue is a shit quality lining that hasn’t been able to be repaired fully (it’s never triple anymore) A few days here or there on a non issue is not what’s going to lead to a Bfn

@Gardenlady543 Hmm, maybe you're right. On the Igenomix website though, they do seem to talk about doing ERA in a natural cycle?

I think the window of implantation they give you is then based on the monitoring of your LH, so after they take the biopsy +7 days after you ovulate, the results then say if the window was good, or if you need to 'rest' for 12h more or less depending on if pre- or post-receptive. Replace 'rest' with progesterone supplementation in a medicated cycle.

When you then go to an unmedicated FET, basically you replicate these results from when you've triggered - so it might turn out that your transfer should take place earlier/later in the day? Although the more I think about this, I'm not sure how that would work - especially because my clinic has fixed days that they do the transfers.

I also agree with what you're saying in that there could be differences between natural cycle to cycle, so I'm not sure now! Why would they say it can be used in natural cycles then? Urgh, confused!

@Cream123 thank you for the kind words; it's so hard because you constantly feel that you're fighting for yourself and having to do your own research. I thought I'd be able to slough some of that feeling off going into this, but sadly not.

@agesandages111 if u do it on an natural cycle (needs to be triggered) then you do it the same on FET. The WIO is much bigger on a natural cycle so the ErA is not needed.I think!

Ok found this I knew I had read it but I can’t find it Google but can’t read it fully...

Reproducibility of the results may be affected by a change in endometrial thickness (should remain within similar range: 12mm), dramatic weight ...

@agesandages111 I mean if the website indicates that they can interpret the results and advise, then that sounds good. It’s not going to be as easy to replicate the situation in a natural cycle and like you say the clinic might be shut, but that’s a risk with the natural cycle anyway.

@Cream123 these lining results sound great, I would say try not to worry, it’s the opposite extreme isn’t it, first worrying about a thin lining now worrying it will be too thick. But honestly I think it would have to be massive to have a negative impact on your outcome. The holiday to relax is going to be the best thing you can do to influence the outcome.

Erg yes I’m so worried about the HSG and ERA/EMMA/ALICE result and thinking about every potential outcome:

HSG normal EMMA ALICE abnormal
HSG normal EMMA ALICE normal
HSG abnormal EMMA ALICE abnormal
HSG abnormal EMMA ALICE normal

@Gardenlady543 not so much worrying re thickness but more if era results won’t be reproducible if lining gets much thicker. I can find the damn page on the ignomix website!

@Gardenlady543 @Cream123 Thanks both - I'm going to seek clarification from Igenomix and also the clinic I've contacted re. the tests and see if they can help shed more light. Although I do want to do everything I can ASAP to ensure things work, I also don't want to throw money away if the benefits aren't clear/obvious.

@Cream123 I think you're looking for the 'FAQ' section on this page (scroll down).

The portion that you pasted to me earlier says this in full:

How long are ERA test results valid for?
When carrying out the same exact medical protocol (same medications, type of cycle, hours of progesterone, administration type, dosage, etc.) and with proper control of endogenous progesterone (endogenous progesterone level measured within the 24 hours prior to the first intake of exogenous progesterone and

Oh just to add, I found a summary of this study - seems to be the only one who's looked at the use of ERA in non-medicated cycles, but it seems like it is a thing that can be done.

Evaluating the use of natural cycle endometrial receptivity array prior to embryo transfer
Fertility and Sterility — Vaughn SJ, et al. | April 10, 2019

The clinical outcomes of natural cycle frozen embryo transfer (NC-FET) after natural cycle-endometrial receptivity array (NC-ERA) were described. Further, patients who had a receptive ERA were compared to those who had a non-receptive endometrial receptivity array (ERA) and thus underwent a subsequent personalized ET (pET).

Between January 2015 and November 2018, researchers identified 36 patients who underwent NC-ERA testing; 24 patients with a receptive ERA result (66.7%) while 12 with a non-receptive ERA result on their first ERA (33.3%).

After pET, results achieved in patients with an initial non-receptive NC-ERA were similar to those with a receptive ERA. However, the independent negative prognostic value of a history of multiple failed transfers remains in these patients. Only a few studies have addressed the use of NC-ERA, including this work.

Ok so that’s my worry ...

That it was 10mm for era and as I’ll be on oestrogen longer

Could go over 12mm

I don’t know how thick my lining gets post my ashermans surgery

@Cream123 hmm “should remain within similar range: 12mm” could mean anything, it could mean that it has to be within 12mm of the ERA thickness and I mean that would be a huge variation. You could get in touch with the company to clarify if you’re worried.

I think it means 6-12mm coz on their website they have a presentation which says ERA is valid for and it says not for linings over 12mm